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Complex Regional Pain Syndrome

Created 23 December 2011, last modified 03 January 2013

Complex Regional Pain Syndrome (CRPS) is a painful condition of a region of the body that usually occurs after an injury, most commonly a fracture. The condition varies in severity and can last for months or years. The cause of CRPS is not known, but early intervention can modify the course of the disorder. Therapy aims to relieve symptoms and restore limb function. CRPS is more common in smokers and likely to affect females than males. Post-menopausal women are at highest risk. In adults it most commonly affects the arm, while in children it most commonly affects the leg. CRPS is also known as Reflex Sympathetic Dystrophy (RSD).

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Types of CRPS

CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury

CRPS 2 is caused by an injury to the nerve

Signs and symptoms

pain in the affected region

pain greater than expected for the injury that has occurred

stiffness

swelling

skin changes

shiny skin

changed temperature of the region

Cause

While the cause of CRPS is uncertain, it is thought to result from dysfunction of the nervous system. There is no cure and no single recommended treatment. Vitamin C (500mg daily) may have a role in preventing CRPS.

Diagnosis

The presence of an initiating noxious event or a cause of immobilization

Continuing pain, perception of pain from a nonpainful stimulus, or an exaggerated sense of pain disproportionate to the inciting event.

Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the area of pain

The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction.

Type 2 involves:

The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve

Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain

The diagnosis is excluded by the existence of any condition that would otherwise account for the degree of pain and dysfunction.

Treatment

CRPS can be managed by a single doctor, but in severe cases it is advisable that a multidisciplinary team be involved. This may include a surgeon, GP, psychologist, hand therapist, anaesthetist and pain medicine specialist. Treatment modalities, which include:

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